As vaccination against COVID-19 is rolled out across the UK people are understandably asking more questions about it. The piece entitled "Vaccine - Update and FAQs" addressed some of the initial questions I was asked, you can click here to read it.
In this piece further questions are addressed and what the vaccination programme means the UK.
Question: If I have had COVID-19 do I still need a vaccine?
The quick answer to this question is “yes” because it is unclear what level of immunity infection itself gives whereas this has been closely studied with the vaccines and the data is more complete.
It is reasonable though to ask that if a person has had COVID-19, and is therefore now immune to it, why do they also need a vaccine?
Further weight was given to this today (14 January 2021) with the publication of a pre-print of a research paper claiming that infection with COVID-19 conferred as much immunity as the vaccine for up to five months. (1)
The study was carried out on 20,000 UK healthcare workers and is the largest study of its kind in the world so far.
6,000 health workers who had previously been infected with COVID-19 were studied alongside 14,000 who had not. Previous infection seemed to give up to 94% protection against further COVID-19 which lasted up to five months.
If natural infection works as well as the vaccine it will certainly help boost immunity across the population. However, we do not yet know if any immunity (from either an infection or the vaccine) prevents a person from catching COVID-19 altogether or if it means COVID-19 infection is now only a mild illness for the immune individual. If the latter then an individual’s immunity will protect only them and not others, it won’t stop them from passing the virus onto others whilst only mildly unwell themselves.
One major caveat with this study was that it was carried out on front line hospital staff. They are not representative of the general population because they are exposed to COVID-19 repeatedly through their work at levels most people do not encounter. It is possible that it is this repeated, constant exposure that has boosted their immunity and it may not be replicated in the general population.
The study also took place before the new variant of the virus took hold in the UK.
The researchers want to expand the study over the next three months to include 100,000 health workers but this will not get round the issue that they are not representative of the general population. The immune responses to COVID-19 infection of a group of people exposed to much higher levels of virus than the norm for most people cannot, I would suggest, be used as evidence that those who have been infected do not need the vaccine. (2)
Why are people who have been vaccinated still getting Covid-19?
No vaccine ever offers 100% protection against a disease. There will always be some people who don’t mount an immune response and remain susceptible to the illness.
The vaccine does not give immediate protection either, it is at least two weeks before it begins to. During these two weeks the individual remains as susceptible to COVID-19 as a non-vaccinated person.
The fact that vaccination is never 100% successful was demonstrated by the reporting of an NHS nurse who contracted COVID-19 between her first and second doses of the vaccine. Although on an individual level this is very disappointing it should be remembered that this is to be expected within any vaccination programme. What cannot be known is if the trajectory of her illness would have been more severe had she not had a first dose of the vaccine. (3)
Will COVID-19 vaccination be enforced by law in the UK?
Some countries do insist on childhood vaccinations although the UK is not one of them.
For example, in nine European countries (Bulgaria, Croatia, Czech Republic, France, Hungary, Italy, Latvia, Poland, Slovakia) childhood vaccination against mumps-measles-rubella is mandatory. The US and Australia also insist on mandatory vaccination and children are not allowed to start school if they have not been vaccinated. This is because between 90% and 95% of children need to be vaccinated against measles to prevent life threatening measles outbreaks. (4)
Studies have shown that it is the wealthier nations that have the most negative views of vaccination whereas most low income countries, particularly those in Africa and South America, view them positively. A large study in 2015 noted that an inverse relationship has developed between vaccine sentiments and socio-economic status, perhaps because the low income countries still deal with the life threatening illnesses on a daily basis and better appreciate the protective effects of vaccination. (5) (6)
Vaccination is not mandatory in the UK with some exceptions. All health care workers who carry out EPPs (Exposure Prone Procedures) must be vaccinated against Hepatitis B and have documentation to prove they have ongoing immunity as a prerequisite for work. There are no current plans for vaccination against COVID-19 to be made mandatory in the UK.
Should organisations and work places play a role in the delivery of the vaccine?
The UK benefits from a centralised NHS (National Health Service) that is overseeing the vaccination programme.
It is unlikely that individual organisations and companies would be asked to take on the vaccination of their staff as all UK citizens will be vaccinated by the NHS.
However there may be ramifications for people refusing to have the vaccine with regard to their employment. For example, a plumbing firm in London has already stated that its employees must be vaccinated against COVID-19. (7)
It is too soon to know how exactly employment law and COVID-19 vaccination are going to mesh together although this article here explores some possibilities. (8)
If, like the annual flu jab, a regular COVID-19 vaccine booster becomes the norm then it may become a prerequisite for some high-risk jobs, much like the Hepatitis B vaccine is for current health workers.
Organisations that regularly send employees overseas, especially to low income countries that are particularly vulnerable disease-wise, may decide they will only send those who have been vaccinated. Alongside this, proof of COVID-19 vaccination may become a prerequisite for travel to many places. This is already the case with Yellow Fever whereby some countries require proof of vaccination before allowing entry.
The future?
The world is only in the first stages of vaccinating against COVID-19. The aim at the moment is not to prevent infection altogether, but to prevent death or severe disease from COVID-19. This is achievable but it remains to be seen how the COVID-19 vaccination programme translates into daily life as we strive to return to normality.
(5) https://edition.cnn.com/2017/06/06/health/vaccine-uptake-incentives/index.html
(7) https://www.bbc.co.uk/news/business-55654229
(8) https://www.pinsentmasons.com/out-law/guides/coronavirus-can-uk-employers-require-staff-vaccinated
